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| |    Internal Fetal Heart-Rate Monitoring by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. During the childbirth process, the healthcare team at the hospital or birth center will continuously evaluate your baby's well-being. Intermittent listening to the heart rate, continuous external fetal monitoring, and internal fetal heart-rate monitoring are some of the tools they can use to gauge how well your baby is handling the stress of labor. What is internal fetal heart-rate monitoring? Internal fetal heart-rate monitoring is the most precise method of evaluating a baby's heart rate during labor. This type of continuous assessment makes sense if it's difficult to hear the heart rate externally, or if the heart rate pattern they are seeing isn’t reassuring. Accuracy is the main advantage to internal fetal heart-rate monitoring, but there's a side benefit as well: You can move around more easily in bed with this type of monitor, so you may be more comfortable than if you were bound by the abdominal belts of an external fetal monitor. How does the internal monitor work? The monitor uses a thin wire to transmit electrical signals from your baby's heart, allowing the heartbeat to be followed moment by moment. (In essence, it produces a fetal electrocardiogram, or EKG.) The heart rate is tracked on a graph, either on paper or in a computer, sometimes both. Usually a visual record of the contractions is kept simultaneously, and the graph can help to see how the baby responds to the contractions. How is the monitor inserted? In order to position an internal monitoring device, the amniotic sac must be ruptured and the cervix of the mother-to-be must be dilated at least one or two centimeters. If your healthcare practitioner recommends internal monitoring and your water hasn't yet broken, she will have to rupture the amniotic sac, a quick and essentially painless procedure called an amniotomy. The insertion of the electrode should be no more uncomfortable than a cervical exam. The electrode is inserted into the vagina, fed through the opening in the cervix, and then attached to the baby's scalp. The thin cable from the electrode extends out of the mother's vagina and is connected to the fetal monitor. One disadvantage of internal fetal monitoring is that the electrode may make a tiny, temporary mark where it was attached to the baby. The risk of infection is also slightly higher for the mother and the baby with this type of monitoring, so it is typically used only when the benefits outweigh these small risks. Does this device monitor contractions as well? No, not directly. But the internal fetal heart-rate monitor may be used with an intrauterine-pressure catheter, which monitors contractions internally, or an external belt that measures the timing of contractions. Do I have to have this type of monitoring? Childbirth is a natural process, and you may be thinking that electrodes and other monitoring devices are as far from natural as could be. If you have a question about whether or not any particular procedure is necessary, feel free to ask your practitioner. Most women in labor don't require more than a check on the fetal heartbeat at regular intervals. Your preferences often can be taken into account, especially in non-emergency circumstances. And while using these monitors may not be your image of the perfect labor, if they become necessary, do keep in mind that you and your practitioner have common goals-the outcome of a healthy baby and a healthy mother!
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